Quality Improvement Plan and Resident Safety Indicators

What is a quality improvement plan

The Quality Improvement Plan is one of the tools that reflects our commitment to ensure the improvement of the quality and safety of care, in compliance with the Act and the regulations relating thereto.

Quality improvement plan for the current year and previous years

Consult the drop-down menus according to the desired year.

2018-2019

Quality Improvement Plan 2018-2019 Overview

The Prescott and Russell Residence therefore has a strategic plan for 2017-2020. This plan identifies several goals and objectives for improving the quality of care and the safety of residents, particularly in such a way as to adapt the offer to the needs of the community, to optimize governance, various resources, and the operation of the organization, to improve internal and external communications, and to continue the implementation and maintenance of the Quality Improvement Program, while having as a backdrop high-quality certification from Accreditation Canada. In partnership with the residents, families, partners, employees, and members of the Board of Directors, the Residence is working this year to reinitialize its strategic plan.

Firstly, the safety of the residents, risk management, and quality improvement are the priority elements of the Residence’s strategic framework.

Secondly, the involvement of residents and families is critical to residents’ care planning. It is also necessary in order to focus on an effective communication process to assess the satisfaction of residents and families through surveys, interdisciplinary meetings, educational workshops, various committees, or others in order to improve quality.

Thirdly, the participation of partners and interdisciplinary teams allows the Residence to perfect communication internally with residents and families and externally with the community and partners. This communication process ensures the implementation of a Quality Improvement Plan based on the real and changing needs of the clientele and on the satisfaction of residents, families, and the community.

Several quality indicators are at the core of the Residence’s policies and procedures. Since the last year, these indicators have allowed us to see simultaneously the reduction of pressure ulcers, the reduction of restraints and falls, and the reduction of antipsychotic administration at the Residence. We have also noticed an increase in the satisfaction of residents, families, and employees, generally following the results obtained through safety and satisfaction surveys. Residents and families feel that they are safe, can express their opinions without fear of consequences, and are very satisfied with their life experience at the Residence.

The Residence also faces certain challenges, notably with regard to the recruitment and retention of qualified personnel, particularly in the nursing field. The quality and safety of the care provided are based on an organizational structure that must provide sufficient human resources in compliance with the Act. The building’s structure also poses some challenges in terms of the limitations it imposes on us, which creates additional human resource needs. That being said, this constraint brings up questions about the management of financial resources.

Since we are always looking for opportunities to ensure good care, at the right time, in the right place, and in the most efficient way possible according to the residents’ needs, we remain on the lookout to continue to improve the range of specialized services on-site to reduce transfers to the emergency and keep our resident in their home environment.

Finally, we used the results obtained as part of our latest Quality Plan, comparable statistical data, the results of various quality and safety surveys, comments, suggestions, and feedback from our residents, families, and employees to focus on a future Quality Plan geared towards resident safety.

Organization’s greatest QI achievements from the past year

Several activities and programs have been put in place to build a safe living environment for residents and a satisfying living environment for employees.

A strong interdisciplinary structure is in place to ensure the safety of residents. Follow-ups are conducted quarterly and as needed to focus on best practices and effective improvement plans.

Quality and safety surveys were distributed to residents, families, and employees to plan to ensure and improve everyone’s satisfaction.

Several care programs, policies, and procedures were implemented and/or revised to ensure the success of our accreditation process with Accreditation Canada, Qmentum level.

A quality improvement chart has been installed and better communicates the results achieved with regard to quality indicators.

A Quality Improvement Committee was set up and reviews the recommendations of the various Interdisciplinary Committees

All quality indicators were met or have exceeded the intended target.

An electronic medical prescription system was initiated.

Resident, Patient, Client Engagement

Engagement of employees, medical team members, external partners, families, residents, Family Council and Residents’ Committee representative to the Quality Improvement, Safety, and Risk Management Interdisciplinary Committee. Transparent communication process with regard to projects, successes, desired objectives, quality indicators with employees, residents, and families. Commit to publishing the successes, events, and completed projects regularly on the Residence’s website in the coming year.

Collaboration and Integration

Collaboration with the Mental Health and Addiction Centre on-site to ensure the well-being and care of residents as the need arises.

Participation in the “Through our eyes” program with the Ontario Association of Resident’s Council.

Measures in place to allow the Residence’s medical team to approve on-site interventions to avoid transfers.

Proposal to increase the number of beds at the Residence following the announcement of the MOHLTC in order to reduce ALC placement beds at the Hospital and also shorten the waiting list of people in the community.

Training and education of employees to be better equipped to deal with residents with disruptive and reactive behaviours (BSO) and to put in place the right prevention and intervention measures and avoid transfers to the hospital.

Engagement of Clinicians, Leadership & Staff

The establishment of a Quality Improvement Committee consolidates the engagement. The membership is interdisciplinary and includes employees from each service sector, family members, volunteers, as well as Residents’ Committee and the Family Council representatives. The Quality Improvement objectives results are reviewed, and graphs of statistics are presented for subsequent internal and external communication. A training video on evacuation procedures was prepared with the participation of employees, the management team, residents and is presented during new employee hiring orientation, is viewed annually on a mandatory basis, and is available on the Residence website. Interdisciplinary Committees are well established and the colossal process of setting up and revising policies and procedures is nearing completion in anticipation of a visit by Accreditation Canada representatives in June. A transparent communication process is in place with the Family Council and the Residents’ Committee.

Population Health and Equity Considerations

Our residence offers care and services in both official languages. The menus can be modified so that the food can meet the needs of the residents according to their culture. We have access to pastoral services in the community to meet the residents’ religious needs and spiritual beliefs. A palliative care program was established for the needs of residents and their families. We adapt the purchase of equipment and our work procedures according to the specific needs of each resident. A wide range of specialized services is on-site to avoid moving the residents and reduce the financial impact. A significant reduction in transfers to the emergency was noted in the past year, and this, beyond our goal.

Access to the Right Level of Care - Addressing problems

Under the recommendation and approval of the Medical Management, a process was put in place to ensure the consistency of internal procedures, based on effective evaluation and interventions. In consultation with the attending Physician, the follow-up of the resident’s condition is carried out rigorously in order to avoid and reduce transfers to the emergency and to keep the resident in their own environment until the very end. We can thus see the success of the measures put in place by the reduction in the number of transfers to the emergency. As a result, the objective set in our Quality Plan last year was met and has been exceeded. In that respect, the resident can therefore continue to benefit from good care, in the right place, and at the right time, through a multidisciplinary and medical team at the Residence and in their living environment.

Opioid Prescribing for the Treatment of Pain and Opioid Use Disorder

A pharmaceutical committee with the participation of the pharmacist and the medical director, reviews the medication of each resident according to individual needs. A Quality, Safety and Risk Management Improvement Committee reviews the recommendations of the pharmaceutical committee and makes recommendations as needed.

Workplace Violence Prevention

The health and safety element of individuals particularly residents, employees, and visitors is one of the objectives included in the Residence’s Strategic Plan and aims to manage the risks associated with the individual’s integrity. Any occurrence dealing with assault, incidents, or violence is reported to the relevant Interdisciplinary Committees, the Quality Improvement, Safety, and Risk Committee, and the Residence Administration Committee. Several initiatives aimed at a healthy and safe workplace were implemented:

Yearly training offered to all employees and volunteers by the Prescott and Russell Residence to promote zero tolerance for abuse and neglect of residents.

A safety survey was conducted with all employees in 2017.

Training offered by the Corporation of the United Counties of Prescott and Russell on the Policy on violence in the workplace, harassment, and discrimination (PER 006).

Each floor has posters, in both official languages, on zero tolerance containing the following text:

“This public building operates in an environment of courtesy and respect. We are committed to maintaining a safe workplace free of harassment for our employees, volunteers, elected officials, and visitors. Aggressive behaviour or abusive language will not be tolerated.”

Incident statistics including incidents involving assaults are posted on the Health and Safety boards. Joint Workplace Health and Safety Committee meetings are held quarterly.

Quality Improvement Plan 2017-2018 Overview

The Quality Improvement Plan is one of the tools that reflects our responsibility to ensure the improvement of the quality and safety of care. The Prescott and Russell Residence has therefore developed a strategic plan and has identified several goals and objectives for improving the quality of care and safety.

We have established several priorities, such as resident safety in every field, listening to the needs centred on the resident’s well-being, increasing specialized services by new advanced technology at the Residence, interdisciplinary work and the empowerment of each employee to meet the individual needs of each resident, training some nurses in specialized areas to provide more complex on-site care and excellence in care and services.

Following the latest Quality Plan, we used the results obtained, comparable statistical data, the quality survey, and feedback from our residents and families to focus on strategic planning that reflects the needs of our residents and the community in accordance with MOHLTC standards.

Since we are always looking for opportunities to provide care at the right time, in the right place, and in the most efficient way possible according to the needs of the residents, we are looking for other partnerships with Specialized Health Care Providers in the community to reduce transfers to the emergency and transportation costs for our residents and families, a mobile radiology service, Dentist, Optometrist, are in place.

QI Achievements From the Past Year

We are trying to continue to reduce the use of restraints with the PASD program and to provide training in this regard on the availability of material resources and with the assistance of interventions aimed at the safety and well-being of residents. One of our objectives for the coming year is to continue to evaluate the real needs in order to reduce the use of restraints while focusing on the resident’s safety.

We have reduced the use of antipsychotics without diagnoses with the participation of the Medical Director and the Pharmacist on the Interdisciplinary Pharmaceutical Committee. One of the Committee’s recommendations was to review all the lists of medications according to the individualized needs of each resident, in collaboration with the treating Physicians. Hence, some therapy changes were able to be made while meeting the resident’s needs. We will therefore maintain quarterly revisions to continue to reduce the use of antipsychotic drugs without a diagnosis.

Population Health

Focus on promoting the residents’ independence in their activities of daily living.

Equity

Training for employees, residents, and families in both official languages.

Integration and Continuity of Care

Several programs were developed and are reviewed as needed:

Fall prevention program (FALL Leaf program.

Continence program (TENA Portraits.

Integrity for skin and wounds program, in collaboration with OMS, SEHC, (ET nurse).

Continuing education program for all employees.

Specific specialized training for Nurses to provide care that is more specialized to our most vulnerable clientele.

Palliative care program - new technologies to reduce and stabilize pain while keeping the resident in their environment and avoiding transfers to the emergency.

Improved communication in an interdisciplinary way and with family members.

Access to the Right Level of Care - Addressing ALC Issues

We have 144 long-term care beds and two respite beds to help the community.

Engagement of Clinicians, Leadership & Staff

Several Interdisciplinary Committees meet every three months. These Committees are mandated to improve the quality of care and services and oversee all the elements indicated in our QIP. In addition to the individuals responsible for each area of expertise at the Residence, a number of specialized external resources, such as a Psychogeriatrician, Health Unit Nurse, Occupational Therapist, Physiotherapist, Medical Director, Dietitian, and Pharmacist participate in these Committees.

Specialized training is provided for our Nurses to focus on the comfort, safety, and well-being of residents regarding their right to receive the best possible care in a long-term care home.

New technologies are also available to maximize our nursing and medical teams’ time to take care of the residents’ well-being.

Resident, Patient, Client Engagement

A Quality Control Technician for nursing care services is responsible for daily monitoring of the quality of basic care.

A Program Quality Control Technician ensures the well-being of residents during recreation.

A Nursing Coordinator ensures the follow-up of various programs and interventions in place as well as the analysis of the results of the interventions.

Two Nursing Team Leaders ensure supervision, follow-up care, routines, and programs to maintain quality and safe care for our residents.

Staff Safety & Workplace Violence

Education offered by Human Resources to employees in all departments.

Other

Learning from previous experience and successes, but also through the engagement, competence, and perseverance of our whole team to surpass themselves at all times, we have chosen a new purpose for the next few years: focus on our human resources to achieve excellence in care and services for our residents and families as well as for members of our community.

Resident Safety Indicators

The Prescott-Russell Residence consistently improves the quality of care and services, while ensuring the safety of the residents. We inform the public with information regarding resident’s safety as part of our quality improvement program.

Diseases related to Clostridium difficile

Clostridium difficile (C. difficile) is a bacterium that causes mild to severe diarrhea and intestinal disorders such as pseudo-membranous colitis (inflammation of the colon). It is the leading cause of infectious diarrhea in hospitals and long-term care facilities in Canada and other industrialized countries. (Public Health Agency of Canada)

2017 Statistics

Period: Decembre 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: November 1-30, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: October 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: September 1-30, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: August 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: July 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: June 1-30, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: May 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: April 1-30, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: March 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: February 1-29, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

Period: January 1-31, 2017

Rate / 1000 days-residents: 0
Number of cases: <5

2018 Statistics

Period: Decembre 1-31, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: November 1-30, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: October 1-31, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: September 1-30, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: August 1-31, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: July 1-31, 2018

Rate / 1000 days-residents: 0.2
Number of cases: <5

Period: June 1-30, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: May 1-31, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: April 1-30, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: March 1-31, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: February 1-29, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Period: January 1-31, 2018

Rate / 1000 days-residents: 0
Number of cases: <5

Bacteria related to MRSA

MRSA, Staphylococcus aureus (staphylococcus) is a type of bacterium that is commonly found on the skin or in the nose of healthy people. Some staphylococcal bacteria are easy to treat and others do not. Staphylococcus bacteria that are resistant to the antibiotic methicillin are known as methicillin-resistant Staphylococcus aureus or MRSA. (Public Health Agency of Canada)

2017 Statistics

Period: Decembre 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: <5

Period: November 1-30, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: October 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: September 1-30, 2017

Rate / 1000 days-residents: 2
Number of cases: >5

Period: August 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: July 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: <5

Period: June 1-30, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: May 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: April 1-30, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: March 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: >5

Period: February 1-29, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

Period: January 1-31, 2017

Rate / 1000 days-residents: 1
Number of cases: 5

2018 Statistics

Period: Decembre 1-31, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: November 1-30, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: October 1-31, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: September 1-30, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: August 1-31, 2018

Rate / 1000 days-residents: n/o
Number of cases: n/o

Period: July 1-31, 2018

Rate / 1000 days-residents: 0.9
Number of cases: <5

Period: June 1-30, 2018

Rate / 1000 days-residents: 1.6
Number of cases: >5

Period: May 1-31, 2018

Rate / 1000 days-residents:0.7
Number of cases: <5

Period: April 1-30, 2018

Rate / 1000 days-residents: 0.7
Number of cases: <5

Period: March 1-31, 2018

Rate / 1000 days-residents: 0.7
Number of cases: <5

Period: February 1-29, 2018

Rate / 1000 days-residents: 1.2
Number of cases: 5

Period: January 1-31, 2018

Rate / 1000 days-residents: 0.9
Number of cases: <5

Bacteria related to ERV

ERV Enterococci are bacteria that are normally present in the urinary tract and human intestines, and are also often found in the environment. Usually, these bacteria do not cause infection. However, when an infection occurs, it can usually be treated with antibiotics. Vancomycin-resistant Enterococci (VRE) are enterococcal strains that have become resistant to the antibiotic vancomycin. (Public Health Agency of Canada)